Can it be prevented?
There are no clear recommendations on how to prevent anomalous accumulation of fat. Although it is generally associated with the use of protease, not all drugs of this type would produce this effect. On the other hand, hypertrophy was also observed in people taking medicines that did not include this type of antiretroviral drugs.
Most protease inhibitors are taken with a small dose of ritonavir, which serves to potentiate its effect. The blood concentration of these inhibitors, as well as ritonavir, can vary greatly between each person.
Some doctors measure these blood levels for the purpose of adjusting the dose if necessary. In this way, the amount of drug ingested by some people may be lower, which can help reduce their toxicity.
Some studies have also found that, with the same technique of measuring blood levels may be safely reduced the dose of efavirenz (Sustiva®, Co-formulated in Atripla®), A drug associated with increased fat, especially chest, both women and men.
Physical exercise regularly and follow a balanced diet, low in saturated fat content could help lessen its impact.
It can be reversed?
Contrary to what occurs with lipoatrophy, the results of studies on changing treatment to stop or reverse hypertrophy are not very clear. When it tested the replacement of a protease inhibitor a non-nucleoside analog, the other two drugs, or are not modified, the nucleoside analogue, which could perhaps be assisted.
In some people, improvement was observed after modifying one of antiretrovirals by T-20 (Fuzeon®) A fusion inhibitor is injected subcutaneously twice daily.
There were also cases in which a change to atazanavir (Reyataz®) Improved visceral fat, although its long-term impact on other symptoms of lipodystrophy is still being studied. Atazanavir is a protease inhibitor which, when ingested without ritonavir, has a very low impact on lipids, although it is more usual eating it with a small dose thereof.
The new Integrase, Raltegravir (Isentress®), It seems to also affect the lipid in the same way, but it is not known what is their real impact on lipodystrophy.
There are people with severe abdominal hypertrophy -when fat compresses the internal organs and compromises vital functions such as breathing or eating food - that may have been benefited by releasing factor of growth hormone (tesamorelin), a drug being tested that has not been approved. Anyway, if not performed another type of intervention, the fat will reappear when you finish the treatment with tesamorelin.
The topical testosterone gel helpful in some cases especially for reducing the growth of the breast in men, gynecomastia effect called.
It is also being tested may have the benefit that the use of drugs for reducing blood fat (cholesterol and triglycerides), or treating insulin resistance (metformin).
Some tests used for other types of diagnostics can also be used to detect the early development of hypertrophy, such as imaging techniques Magnetic resonance imaging (MRI in English). Lets get a digital image of a cross section of the body. It is very useful to see the visceral fat that accumulates around the organs inside the abdomen.
In the case of fat accumulation may be done safely liposuction the following areas:
- Back of the neck, shoulders and back (buffalo hump).
- Chest, both men and women.
- Other accumulations located.
Some public hospitals offer this technique. You can get information about how to access it in your Autonomous Community, addressing the organizations included in the list at the end of this document or PDF 21 page.
In many cases, the fat reappears. Modify some combination of drugs after liposuction could help to prevent or minimize this effect. Can you talk about this with your doctor.
The fat accumulated inside the abdomen can not be extracted by liposuction because it is located between the organs, and use this technique in this region would be very dangerous.
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